Provider Demographics
NPI:1134415862
Name:WOODALL, DONNA (PHARMD)
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:
Last Name:WOODALL
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12131 PRESERVE LN
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TN
Mailing Address - Zip Code:38002-4614
Mailing Address - Country:US
Mailing Address - Phone:901-758-3626
Mailing Address - Fax:901-213-2362
Practice Address - Street 1:139 WESLEY REED DR STE F
Practice Address - Street 2:
Practice Address - City:ATOKA
Practice Address - State:TN
Practice Address - Zip Code:38004-4918
Practice Address - Country:US
Practice Address - Phone:901-837-8801
Practice Address - Fax:901-837-5014
Is Sole Proprietor?:No
Enumeration Date:2011-06-21
Last Update Date:2022-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN130461835P0018X, 183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist